Pre-pregnancy overweight or obesity and gestational diabetes as predictors of body composition in offspring twenty years later : evidence from two birth cohort studies

Background. Global prevalence of overweight/obesity and gestational diabetes (GDM) is increasing. In pregnant women both conditions affect offspring's later health. Overweight/obesity is a risk factor of GDM; to what extent maternal overweight/obesity explains long-term effects of GDM in offspring is unknown. Objective. To evaluate effects of maternal pre-pregnancy overweight/obesity (BMI ⩾25 kg/m2) and GDM, occurring together or separately, on body composition among adult offspring. Methods. Participants include 891 individuals aged 24.1 years (s.d. 1.4) from two longitudinal cohort studies (ESTER and AYLS). Adult offspring of normoglycemic mothers with overweight/obesity (ONOO, n=153), offspring of mothers with GDM (OGDM; n=191) and controls (n=547) underwent anthropometric measurements and bioimpedance analysis. GDM was diagnosed by oral glucose tolerance test. Data were analyzed by linear regression models adjusted for confounders. Results. Compared with controls, ONOO-participants showed higher BMI [men 1.64 kg/m2 (95% confidence interval 0.57, 2.72); women 1.41 kg/m2 (0.20, 2.63)] and fat percentage [men 2.70% (0.99, 4.41); women 2.98% (0.87, 5.09)] with larger waist circumferences [men 3.34 cm (0.68, 5.99); women 3.09 cm (0.35, 5.83)]. Likewise, OGDM-participants showed higher fat percentage [men 1.97% (0.32, 3.61); women 2.32% (0.24, 4.41)]. BMI was non-significantly different between OGDM-participants and controls [men 0.88kg/m2 (-0.17, 1.92); women 0.82 kg/m2 (-0.39, 2.04)]. Also waist circumferences were larger [men 2.63 cm (-0.01, 5.28); women 3.39 cm (0.60, 6.18)], this difference was statistically significant in OGDM-women only. Differences in body composition measures were stronger among offspring of women with both GDM and overweight/obesity. For instance, fat mass was higher among OGDM-participants of overweight mothers [men 4.24 kg (1.36, 7.11) vs controls; women 5.22 kg (1.33, 9.11)] than OGDM participants of normal weight mothers [men 1.50 kg (-2.11, 5.11) higher vs controls; women 1.57 kg (-3.27, 6.42)]. Conclusions. Maternal pre-pregnancy overweight and GDM are associated with unhealthy body size and composition in offspring over 20 years later. Effects of maternal pre-pregnancy overweight appear more pronounced

Lung function in adults born preterm

Very preterm birth, before the gestational age (GA) of 32 weeks, increases the risk of obstructed airflow in adulthood. We examined whether all preterm births (GA<37 weeks) are associated with poorer adult lung function and whether any associations are explained by maternal, early life/neonatal, or current life factors. Participants of the ESTER Preterm Birth Study, born between 1985 and 1989 (during the pre-surfactant era), at the age of 23 years participated in a clinical study in which they performed spirometry and provided detailed medical history. Of the participants, 139 were born early preterm (GA<34 weeks), 239 late preterm (GA: 34-<37 weeks), and 341 full-term (GA≥37 weeks). Preterm birth was associated with poorer lung function. Mean differences between individuals born early preterm versus full-term were -0.23 standard deviation (SD) (95% confidence interval (CI): -0.40, -0.05)) for forced vital capacity z-score (zFVC), -0.44 SD (95% CI -0.64, -0.25) for forced expiratory volume z-score (zFEV1), and -0.29 SD (95% CI -0.47, -0.10) for zFEV1/FVC. For late preterm, mean differences with full-term controls were -0.02 SD (95% CI -0.17, 0.13), -0.12 SD (95% CI -0.29, 0.04) and -0.13 SD (95% CI -0.29, 0.02) for zFVC, zFEV1, and zFEV1/FVC, respectively. Examination of finer GA subgroups suggested an inverse non-linear association between lung function and GA, with the greatest impact on zFEV1 for those born extremely preterm. The subgroup means were GA<28 weeks: -0.98 SD; 28-<32 weeks: -0.29 SD; 32-<34 weeks: -0.44 SD; 34-<36 weeks: -0.10 SD; 36-<37weeks: -0.11 SD; term-born controls (≥37weeks): 0.02 SD. Corresponding means for zFEV1/FVC were -1.79, -0.44, -0.47, -0.48, -0.29, and -0.02. Adjustment for maternal pregnancy conditions and socioeconomic and lifestyle factors had no major impact on the relationship. Preterm birth is associated with airflow limitation in adult life. The association appears to be attributable predominantly to those born most immature, with only a modest decrease among those born preterm at later gestational ages.</p

Preterm birth and cardiometabolic risk factors in adolescence and early adulthood

Abstract About 11% of infants are born preterm (before 37 weeks of gestation) worldwide. Adults born preterm with very low birth weight show enhancement of cardiometabolic risk factors such as elevated blood pressure and impaired glucose regulation compared with their peers born at term. Not all the cardiometabolic risk factors related to preterm birth are known, or whether they apply to those born less preterm, although about 80% of premature infants are born late preterm. The association between preterm birth and cardiometabolic risk factors in adolescence and adulthood was investigated in three cohort studies: The Helsinki Study of Very Low Birth Weight Adults, the Northern Finland Birth Cohort 1986, and the ESTER study. Preterm birth over its whole range has a long-term impact on a child’s health in later life: adults born preterm with very low birth weight had lower resting energy expenditure, but higher resting energy expenditure per unit lean body mass than their peers born at term. Adolescent girls born before 34 weeks of gestation had higher blood pressure and boys have elevated levels of LDL cholesterol and apolipoprotein B. Adults born preterm were more likely to be obese and to have hypertension or metabolic syndrome than their peers born at term. In addition to conventional biomarkers of cardiometabolic disorders, they had alterations in other cardiometabolic biomarkers, such as uric acid and liver transaminases. Adolescents and adults born preterm are at greater risk of developing cardiometabolic disorders than their peers born at term. Most of the cardiometabolic risk factors related to preterm birth are modifiable. Favorable early life circumstances of premature infants, such as optimal nutrition and reduction of stress in neonatal intensive care units, might reduce the risk of later cardiometabolic disorders. In addition, children and adults born preterm might particularly benefit from primary prevention such as screening for additional risk factors and promotion of healthy lifestyles.Tiivistelmä Noin joka yhdeksäs lapsi maailmassa syntyy ennenaikaisesti, ennen 37. raskausviikkoa. Keskosena syntyneillä aikuisilla on todettu enemmän joitakin sydän- ja verisuonisairauksien riskitekijöitä kuin heidän täysaikaisena syntyneillä ikätovereillaan. Näistä eniten on tutkittu etenkin kohonneen verenpaineen ja heikentyneen sokerin siedon esiintyvyyttä, mutta kaikkia myöhempien sairauksien riskitekijöitä ei tunneta. Suurin osa aiemmista keskostutkimuksista on tehty hyvin tai erittäin ennenaikaisesti syntyneillä, vaikka yli 80% keskosista syntyy lievästi ennenaikaisena. Ei ole juurikaan tutkimuksia siitä, ovatko sydän- ja verisuonitautien riskitekijät lisääntyneet myös tässä suuressa lievemmin ennenaikaisesti syntyneiden joukossa. Eriasteisen ennenaikaisen syntymän vaikutuksia nuoruus- ja aikuisiän sydän- ja verisuonitautien riskitekijöihin tutkittiin kolmessa kohorttitutkimuksessa: Helsingin Pikku-K -tutkimuksessa, Pohjois-Suomen syntymäkohortti 1986 -tutkimuksessa sekä ESTER-tutkimuksessa. Ennenaikaisella syntymällä sinänsä on pitkäaikaiset vaikutuksen syntyneen lapsen terveyteen myös nuoruudessa ja aikuisuudessa: Hyvin pienipainoisena ennenaikaisesti syntyneillä on korkeampi lepoenergian kulutus rasvatonta painoyksikköä kohden kuin täysiaikaisena syntyneillä ikätovereilla. Hyvin ennenaikaisena (ennen 34. raskausviikkoa) syntyneillä tytöillä on 16-vuotiaina korkeampi verenpaine, ja pojilla suuremmat LDL-kolesterolin ja apolipoproteiini B:n pitoisuudet. Keskosena syntyneet puolestaan täyttivät aikuisina todennäköisemmin lihavuuden, verenpainetaudin ja metabolisen oireyhtymän kriteerit. Perinteisten sydän- ja verisuonitautien riskitekijöiden lisäksi heillä oli muutoksia myös monissa muissa sydän- ja verisuonitautien merkkiaineissa, kuten uraatin ja maksa-arvojen pitoisuuksissa. Ennenaikaisesti syntyneillä nuorilla ja aikuisilla on suurentunut riski sairastua sydän- ja verisuonitauteihin myöhemmällä iällä. Näitä riskejä on mahdollista ennaltaehkäistä, minkä vuoksi ennenaikaisesti syntyneet nuoret ja aikuiset voivat hyötyä terveellisistä elämäntavoista erityisen paljon

Food and nutrient intakes in young adults born preterm

Background Adults born preterm have higher levels of cardiometabolic risk factors than their term-born peers. Studies have suggested that at least those born smallest eat less healthily. We examined the association between early (<34 weeks) and late (34 to 36 weeks) preterm birth and diet and food preferences in adult age. Methods Participants of two cohort studies located in Finland completed a validated food frequency questionnaire(FFQ) at age 24y to assess their usual diet and the adherence to healthy eating guidelines by using a recommended diet index(RDI).182 were born early preterm, 352 late preterm and 631 were term born controls. Results Young women born early preterm scored 0.77 points (95% CI 0.03, 1.51) lower in RDI when adjusted for sex, age, parental education and early life confounders, indicating a lower quality of diet. There were no differences between young women born late preterm and controls or among men. When food groups were assessed separately, men born early preterm had lower consumption of fruits and berries than controls. Conclusions Young women born early preterm have poorer adherence to healthy eating guidelines than their peers born at term. Differences in diet may contribute to increased cardiometabolic risk among adults born early preterm

Objectively measured physical activity and sedentary time in young adults born preterm:the ESTER study

Abstract Background: Young adults born preterm have higher levels of cardio metabolic risk factors and they report less physical activity than their peers born at term. Physical activity provides important cardio metabolic health benefits. We hypothesized that objectively measured physical activity levels are lower and time spent sedentary is higher among preterm-born individuals compared with controls. Methods: We studied unimpaired participants of the ESTER birth cohort study at age 23.3 y (SD: 1.2): 60 born early preterm (<34 wk), 108 late preterm (34–36 wk), and 178 at term (controls). Physical activity and sedentary time were measured by hip-worn accelerometer (ActiGraph). Results: As compared with controls’ (mean physical activity, 303 counts per minute (cpm; SD 129)), physical activity was similar among adults born early preterm (mean difference = 21 cpm, 95% CI −61, 19) or late preterm (5 cpm, −27, 38). Time spent sedentary was also similar. Adjustments for early life confounders or current mediating characteristics did not change the results. Conclusion: In contrast to our hypothesis, we found no difference in objectively measured physical activity or time spent sedentary between adults born preterm and at term. The previously reported differences may be limited to physical activity captured by self-report

Musculoskeletal pain in adults born preterm: evidence from two birth cohort studies

Background Individuals born preterm are at risk of later developmental problems and long‐term morbidities. There is conflicting evidence regarding musculoskeletal pain in young adulthood. We investigated the prevalence of self‐reported musculoskeletal pain in young adults born across the range of preterm birth compared with a term‐born reference group. Methods From two Finnish birth cohorts, 184 individuals born early preterm (<34 weeks), 350 late preterm (34 to <37 weeks) and 641 at term completed a self‐report questionnaire of musculoskeletal pain at mean age 24.1 (SD: 1.4) years. Group differences were examined by logistic regression models adjusting for sex, age and cohort (Model 1), potential early life confounders (Model 2) and lifestyle factors related to physical (Model 3) and mental health (Model 4). Results The late preterm group had lower odds for reporting neck pain (0.73; 95% confidence interval (CI): 0.56–0.96), which was further reduced when adjusting for early life confounders and lifestyle factors (Model 4). Odds for reporting peripheral pain were 0.69 (95% CI: 0.48–0.99, Model 4) in the early preterm group. The odds for reporting any pain, shoulder, low back or widespread pain did not differ significantly between groups, although odds for reporting widespread pain were 0.77 (95% CI: 0.58–1.03, Model 4) in the late preterm group. Conclusions We did not find evidence of increased prevalence of musculoskeletal pain in adults born early or late preterm. In contrast, our results suggest that adults born preterm have a slightly lower risk of reporting musculoskeletal pain, also when we adjusted for lifestyle factors. Significance Young adults born preterm do not have increased rates of musculoskeletal pain. Our findings rather suggest that these rates may be slightly lower than among those born at term

Pre-pregnancy overweight or obesity and gestational diabetes as predictors of body composition in offspring twenty years later: evidence from two birth cohort studies

BACKGROUND: Global prevalence of overweight/obesity and gestational diabetes (GDM) is increasing. In pregnant women both conditions affect offspring’s later health. Overweight/obesity is a risk factor of GDM; to what extent maternal overweight/obesity explains long-term effects of GDM in offspring is unknown. OBJECTIVE: To evaluate effects of maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾ 25 kg m − 2) and GDM, occurring together or separately, on body composition among adult offspring. METHODS: Participants include 891 individuals aged 24.1 years (s.d. 1.4) from two longitudinal cohort studies (ESTER and AYLS). Adult offspring of normoglycemic mothers with overweight/obesity (ONOO, n = 153), offspring of mothers with GDM (OGDM; n = 191) and controls (n = 547) underwent anthropometric measurements and bioimpedance analysis. Gestational diabetes mellitus was diagnosed by oral glucose tolerance test. Data were analyzed by linear regression models adjusted for confounders. RESULTS: Compared with controls, ONOO-participants showed higher BMI (men 1.64 kg m − 2 (95% confidence interval 0.57, 2.72); women 1.41 kg m − 2 (0.20, 2.63)) and fat percentage (men 2.70% (0.99, 4.41); women 2.98% (0.87, 5.09)) with larger waist circumferences (men 3.34 cm (0.68, 5.99); women 3.09 cm (0.35, 5.83)). Likewise, OGDM-participants showed higher fat percentage (men 1.97% (0.32, 3.61); women 2.32% (0.24, 4.41)). Body mass index was non-significantly different between OGDM-participants and controls (men 0.88 kg m − 2 (−0.17, 1.92); women 0.82 kg m − 2 (−0.39, 2.04)). Also waist circumferences were larger (men 2.63 cm (−0.01, 5.28); women 3.39 cm (0.60, 6.18)); this difference was statistically significant in OGDM-women only. Differences in body composition measures were stronger among offspring of women with both GDM and overweight/obesity. For instance, fat mass was higher among OGDM-participants of overweight mothers (men 4.24 kg (1.36, 7.11) vs controls; women 5.22 kg (1.33, 9.11)) than OGDM participants of normal weight mothers (men 1.50 kg (−2.11, 5.11) higher vs controls; women 1.57 kg (−3.27, 6.42)). CONCLUSIONS: Maternal pre-pregnancy overweight and GDM are associated with unhealthy body size and composition in offspring over 20 years later. Effects of maternal pre-pregnancy overweight appear more pronounced